无症状和发育不良髋关节的髋臼扇区角度：定义发育不良和指导管理的阈值。
Acetabular Sector Angles in Asymptomatic and Dysplastic Hips: Defining Dysplasia and Thresholds to Guide Management.
机构信息
Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
Department of Orthopaedic Surgery, University Hospital Antwerp, Edegem, Belgium.
出版信息
J Bone Joint Surg Am. 2023 Nov 1;105(21):1709-1720. doi: 10.2106/JBJS.23.00022. Epub 2023 Jul 24.
BACKGROUND
Radiographic evaluation plays an important role in detecting and grading hip dysplasia. Acetabular sector angles (ASAs) measure the degree of femoral head coverage provided by the acetabulum on computed tomographic (CT) scans. In this study, we aimed to determine ASA values at different axial levels in a control cohort with asymptomatic, high-functioning hips without underlying hip pathology and a study group with symptomatic, dysplastic hips that underwent periacetabular osteotomy (PAO), thereby defining the ASA thresholds for hip dysplasia.
METHODS
This was a cross-sectional study evaluating a control group of 51 patients (102 hips) and a study group of 66 patients (72 hips). The control group was high-functioning and asymptomatic, with an Oxford Hip Score of >43, did not have osteoarthritis (Tönnis grade ≤1), underwent a pelvic CT scan, had a mean age (and standard deviation) of 52.1 ± 5.5 years, and was 52.9% female. The study group had symptomatic hip dysplasia treated with PAO, had a mean age of 29.5 ± 7.3 years, and 83.3% was female. Anterior ASA (AASA) and posterior ASA (PASA) were measured at 3 axial CT levels to determine equatorial, intermediate, and proximal ASA. The thresholds for dysplasia were determined using receiver operating characteristic (ROC) curve analysis, including the area under the curve (AUC).
RESULTS
Patients with dysplasia had significantly smaller ASAs compared with the control group; the differences were most pronounced for proximal AASAs and proximal and intermediate PASAs. The control group had a mean proximal PASA of 162° ± 17°, yielding a threshold for dysplasia of 137° (AUC, 0.908). The mean intermediate PASA for the control group was 117° ± 11°, yielding a threshold of 107° (AUC, 0.904). The threshold for anterior dysplasia was 133° for proximal AASA (AUC, 0.859) and 57° for equatorial AASA (AUC, 0.868). The threshold for posterior dysplasia was 102° for intermediate PASA (AUC, 0.933).
CONCLUSIONS
Measurement of ASA is a reliable tool to identify focal acetabular deficiency with high accuracy, aiding diagnosis and management. A proximal PASA of <137° or an intermediate PASA of <107° should alert clinicians to the presence of dysplasia.
LEVEL OF EVIDENCE
Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
背景
影像学评估在髋关节发育不良的检测和分级中起着重要作用。髋臼扇形角（ASA）测量髋臼对股骨头覆盖的程度，通过 CT 扫描。在这项研究中，我们旨在确定在无症状、功能正常的髋关节对照组和接受髋臼周围截骨术（PAO）治疗的有症状、发育不良髋关节的研究组中，不同轴向水平的 ASA 值，从而确定髋关节发育不良的 ASA 阈值。
方法
这是一项横断面研究，评估了 51 例患者（102 髋）的对照组和 66 例患者（72 髋）的研究组。对照组为功能正常且无症状，牛津髋关节评分>43 分，无骨关节炎（Tönnis 分级≤1），行骨盆 CT 扫描，平均年龄（标准差）为 52.1±5.5 岁，女性占 52.9%。研究组为有症状的髋关节发育不良，接受 PAO 治疗，平均年龄 29.5±7.3 岁，83.3%为女性。在 3 个轴向 CT 水平测量前 ASA（AASA）和后 ASA（PASA），以确定赤道、中间和近端 ASA。使用接收者操作特征（ROC）曲线分析确定发育不良的阈值，包括曲线下面积（AUC）。
结果
与对照组相比，发育不良患者的 ASA 明显较小；最明显的差异是近端 AASA 和近端及中间 PASA。对照组的近端 PASA 平均值为 162°±17°，发育不良的阈值为 137°（AUC，0.908）。对照组的中间 PASA 平均值为 117°±11°，发育不良的阈值为 107°（AUC，0.904）。近端 AASA 前发育不良的阈值为 133°（AUC，0.859），赤道 AASA 后发育不良的阈值为 57°（AUC，0.868）。中间 PASA 后发育不良的阈值为 102°（AUC，0.933）。
结论
ASA 的测量是一种可靠的工具，可高度准确地识别局灶性髋臼缺陷，有助于诊断和治疗。如果近端 PASA<137°或中间 PASA<107°，则应提醒临床医生注意发育不良的存在。
证据水平
诊断 III 级。请参阅作者说明以获取完整的证据水平描述。
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